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First results of the randomised UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015): The FAST Trialists group

First results of the randomised UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015): The FAST Trialists group
First results of the randomised UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015): The FAST Trialists group
Background and purpose
Randomised trials testing 15- or 16-fraction regimens of adjuvant radiotherapy in women with early breast cancer have reported favourable outcomes compared with standard fractionation. To evaluate hypofractionation further, two 5-fraction schedules delivering 1 fraction per week have been tested against a 25-fraction regimen.

Materials and methods
Women aged 50years with node negative early breast cancer were randomly assigned after microscopic complete tumour resection to 50Gy in 25 fractions versus 28.5 or 30Gy in 5 once-weekly fractions of 5.7 or 6.0Gy, respectively, to the whole breast. The primary endpoint was 2-year change in photographic breast appearance.

Results
Nine hundred and fifteen women were recruited from 2004 to 2007. Seven hundred and twenty-nine patients had 2-year photographic assessments. Risk ratios for mild/marked change were 1.70 (95% CI 1.26–2.29, p<0.001) for 30Gy and 1.15 (0.82–1.60, p=0.489) for 28.5Gy versus 50Gy. Three-year rates of physician-assessed moderate/marked adverse effects in the breast were 17.3% (13.3–22.3%, p<0.001) for 30Gy and 11.1% (7.9–15.6%, p=0.18) for 28.5Gy compared with 9.5% (6.5–13.7%) after 50Gy. With a median follow-up in survivors of 37.3months, 2 local tumour relapses and 23 deaths have occurred.

Conclusions
At 3years median follow-up, 28.5Gy in 5 fractions is comparable to 50Gy in 25 fractions, and significantly milder than 30Gy in 5 fractions, in terms of adverse effects in the breast.
breast cancer, radiotherapy, hypfractionation
0167-8140
93-100
Agrawal, R.K.
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Alhasso, A.
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Barrett-Lee, P.J.
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Bliss, J.M.
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Bliss, P.
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Bloomfield, D.
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Bowen, J.
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Brunt, A.M.
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Donovan, E.
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Emson, M.
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Goodman, A
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Harnett, A.
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Haviland, J.S.
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Kaggwa, R.
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Morden, J.P.
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Robinson, A.
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Simmons, S.
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Stewart, A.
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Sydenham, M.A.
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Syndikus, I.
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Tremlett, J.
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Tsang, Y.
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Wheatley, D.
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Venables, K.
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Yarnold, J.R.
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FAST Trialist group
Agrawal, R.K.
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Alhasso, A.
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Barrett-Lee, P.J.
93eae7ba-8dcf-412d-bee1-a09634cc8b69
Bliss, J.M.
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Bliss, P.
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Bloomfield, D.
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Bowen, J.
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Brunt, A.M.
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Donovan, E.
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Emson, M.
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Goodman, A
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Harnett, A.
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Haviland, J.S.
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Kaggwa, R.
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Morden, J.P.
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Robinson, A.
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Simmons, S.
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Stewart, A.
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Sydenham, M.A.
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Syndikus, I.
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Tremlett, J.
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Tsang, Y.
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Wheatley, D.
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Venables, K.
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Yarnold, J.R.
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Agrawal, R.K., Alhasso, A., Barrett-Lee, P.J., Bliss, J.M., Bliss, P., Bloomfield, D., Bowen, J., Brunt, A.M., Donovan, E., Emson, M., Goodman, A, Harnett, A., Haviland, J.S., Kaggwa, R., Morden, J.P., Robinson, A., Simmons, S., Stewart, A., Sydenham, M.A., Syndikus, I., Tremlett, J., Tsang, Y., Wheatley, D., Venables, K. and Yarnold, J.R. , FAST Trialist group (2011) First results of the randomised UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015): The FAST Trialists group. Radiotherapy and Oncology, 100 (1), 93-100. (doi:10.1016/j.radonc.2011.06.026).

Record type: Article

Abstract

Background and purpose
Randomised trials testing 15- or 16-fraction regimens of adjuvant radiotherapy in women with early breast cancer have reported favourable outcomes compared with standard fractionation. To evaluate hypofractionation further, two 5-fraction schedules delivering 1 fraction per week have been tested against a 25-fraction regimen.

Materials and methods
Women aged 50years with node negative early breast cancer were randomly assigned after microscopic complete tumour resection to 50Gy in 25 fractions versus 28.5 or 30Gy in 5 once-weekly fractions of 5.7 or 6.0Gy, respectively, to the whole breast. The primary endpoint was 2-year change in photographic breast appearance.

Results
Nine hundred and fifteen women were recruited from 2004 to 2007. Seven hundred and twenty-nine patients had 2-year photographic assessments. Risk ratios for mild/marked change were 1.70 (95% CI 1.26–2.29, p<0.001) for 30Gy and 1.15 (0.82–1.60, p=0.489) for 28.5Gy versus 50Gy. Three-year rates of physician-assessed moderate/marked adverse effects in the breast were 17.3% (13.3–22.3%, p<0.001) for 30Gy and 11.1% (7.9–15.6%, p=0.18) for 28.5Gy compared with 9.5% (6.5–13.7%) after 50Gy. With a median follow-up in survivors of 37.3months, 2 local tumour relapses and 23 deaths have occurred.

Conclusions
At 3years median follow-up, 28.5Gy in 5 fractions is comparable to 50Gy in 25 fractions, and significantly milder than 30Gy in 5 fractions, in terms of adverse effects in the breast.

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Published date: July 2011
Keywords: breast cancer, radiotherapy, hypfractionation
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 355637
URI: https://eprints.soton.ac.uk/id/eprint/355637
ISSN: 0167-8140
PURE UUID: 46c9eead-44b8-46a9-b015-e8508ab21d3c

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Date deposited: 03 Sep 2013 10:11
Last modified: 18 Nov 2019 20:37

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Contributors

Author: R.K. Agrawal
Author: A. Alhasso
Author: P.J. Barrett-Lee
Author: J.M. Bliss
Author: P. Bliss
Author: D. Bloomfield
Author: J. Bowen
Author: A.M. Brunt
Author: E. Donovan
Author: M. Emson
Author: A Goodman
Author: A. Harnett
Author: J.S. Haviland
Author: R. Kaggwa
Author: J.P. Morden
Author: A. Robinson
Author: S. Simmons
Author: A. Stewart
Author: M.A. Sydenham
Author: I. Syndikus
Author: J. Tremlett
Author: Y. Tsang
Author: D. Wheatley
Author: K. Venables
Author: J.R. Yarnold

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